(c) McGraw-Hill 2011

1. Chapter 8
Medication for
Mental Disorders
© 2011 McGraw-Hill Higher Education. All rights reserved.

2. Mental Disorders:
The Medical Model
 Model: symptoms diagnosis
determination of cause treatment cure
 Criticisms of model:
 Usually the only symptoms of mental disorders are
behavioral
 Behaviors are varied and can have many causes
 Model guides much of current thinking
 Psychoactive drugs are used to control symptoms of
mental illness
 Researchers seek to identify chemical imbalances
associated with specific mental disorders
© 2011 McGraw-Hill Higher Education. All rights reserved.

3. Classification of Mental
Disorders
 APA Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR) provides
criteria for classifying mental disorders
 Includes hundreds of specific diagnostic
categories
 Widely used classification system
© 2011 McGraw-Hill Higher Education. All rights reserved.

4. Mental Disorders
 Anxiety disorders—characterized by
excessive worry, fears, or avoidance
 Panic disorder
 Specific phobia
 Social phobia
 Obsessive-compulsive disorder
 Posttraumatic stress disorder
 Generalized anxiety disorder
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5. Mental Disorders
 Psychosis—a serious mental disorder involving
loss of contact with reality
 Schizophrenia—chronic
psychosis characterized by
delusions, hallucinations,
disorganized speech and
behavior, and lack of emotional
response; causes significant
interference with social and/or
occupational functioning
© 2011 McGraw-Hill Higher Education. All rights reserved.

6. Mental Disorders
 Mood disorders—
characterized by depressed
or manic symptoms
 Major depression
 Manic episodes
 Bipolar disorder
 Symptoms don’t always fit
neatly into diagnostic
categories
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7. Early Treatment of Mental
Disorders
 Syphilitic infection and malaria
therapy
 In the early twentieth century, many
psychotic patients were suffering
from syphilitic infection of the
nervous system (general paresis)
 Fever associated with malaria was
thought to improve the condition
 Antibiotics were developed that
cured syphilis
© 2011 McGraw-Hill Higher Education. All rights reserved.

8. Early Treatment of Mental
Disorders
 Early drug therapy
 Narcosis therapy: depressants used to induce sleep
 Intravenous thiopental sodium (“truth serum”) used
during psychotherapy to help patients express
themselves
 Insulin-shock therapy
 Electroconvulsive therapy: it was incorrectly
believed that inducing convulsions with drugs or
electric shocks would cure schizophrenia
 Sedatives used in severely disturbed patients
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9. Antipsychotics: Discovery of
Phenothiazines
 Called tranquilizers, neuroleptics, or
antipsychotics
 Reduce psychotic symptoms without
causing sedation
 Following introduction of drug therapy,
restraints and treatments like convulsive
therapy were reduced or discontinued
among hospitalized patients
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10. Antipsychotics: Treatment
Considerations
 Treatment with phenothiazines found to be
more effective than a placebo
 Patients relapse when therapy is
discontinued
 Two groups of antipsychotics
 Conventional (introduced before mid-1990s)
 Atypical (introduced in the past 10 years)
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11. Antipsychotics:
Mechanisms of Action
 Antipsychotics produce
pseudoparkinsonism, indicating a link to
dopamine receptors
 Time delay in drug effects indicates that
the mechanism of action is probably more
complex
 Atypical antipsychotics block both D2
dopamine and 5HT2A serotonin receptors
 Produce less pseudoparkinsonism
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12. Antipsychotics: Side Effects
 Safe in that they are not addictive and are
difficult to use to commit suicide
 Side effects
 Some allergic reactions (jaundice, skin rashes)
 Photosensitivity (easily sunburned)
 Agranulocytosis (low white blood cell count)
 Movement disorders (tremors, muscle rigidity,
shuffling walk, masklike face)
 Tardive dyskinesia
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13. Antipsychotics: Long-term
Effectiveness
 Even patients experiencing success tend to stop taking
the drug
 Short-term efficacy exists, but long-term appears to be
considerably lower
 No clear evidence that atypical antipsychotics work
better than conventional
 When used in children there is a high risk of weight gain
and metabolic changes
 Elderly patients with dementia have a significant
increase in death risk from cardiovascular and other
problems.
© 2011 McGraw-Hill Higher Education. All rights reserved.

14. Antidepressants: Major Types
 Monoamine oxidase (MAO)
inhibitors
 Examples: phenelzine, tranylcypromine
 Tricyclic antidepressants
 Examples: amitriptyline, doxepin,
nortriptyline
 Selective serotonin reuptake
inhibitors (SSRIs)
 Examples: fluoxetine, sertraline,
venlafaxine
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15. Monoamine Oxidase Inhibitors
 Discovered when a drug for tuberculosis
was found to also elevate mood
 Work by increasing the availability of
serotonin, norepinephrine, and dopamine
 Limited use due to side effects and toxicity
 Users must avoid certain foods and drugs to
prevent severe side effects
© 2011 McGraw-Hill Higher Education. All rights reserved.

16. Tricyclic Antidepressants
 Discovered when researchers were working to
create a better phenothiazine antipsychotic and
found a drug that improved mood
 May work by reducing the uptake (and thereby
increasing the availability) of norepinephrine,
dopamine, and serotonin
 Not effective in all patients, but they reduce the
severity and duration of depressive episodes
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17. Selective Serotonin Reuptake
Inhibitors
 SSRIs may work by reducing the uptake (and
thereby increasing the availability) of serotonin
 Safer than tricyclic antidepressants, less likely to
lead to overdose deaths
 Only a little more effective than placebo
 Strong warning from FDA about an increased
risk of suicidal tendencies in children and
adolescents
© 2011 McGraw-Hill Higher Education. All rights reserved.

18. Antidepressants:
Mechanism of Action
 Appear to work by increasing the
availability of norepinephrine or serotonin
 A lag period before improvement in mood
is seen
 We don’t yet have the complete picture of
how antidepressants work
© 2011 McGraw-Hill Higher Education. All rights reserved.

19. Electroconvulsive Therapy
 Most effective treatment for relieving
severe depression
 Works very rapidly, more quickly than
antidepressant drugs
 Best treatment choice in cases with a risk
of suicide
 Can be used in conjunction with drugs
© 2011 McGraw-Hill Higher Education. All rights reserved.

20. Mood Stabilizers
 Lithium: Approved for U.S. sale in 1970
 Early studies found it to be effective in manic
patients
 Acceptance slow in United States
 Previous history of poisonings
 Low perception of seriousness of mania
 U.S. drug approval and sale process
 Can be safe or toxic; blood levels must be
monitored
 High rate of patient noncompliance
© 2011 McGraw-Hill Higher Education. All rights reserved.

21. Mood Stabilizers
 Lithium
 Normalizes mood in bipolar patients,
preventing both mania and depressed mood
swings
 Little effect in treating unipolar depression
 Other mood stabilizers are anticonvulsant
drugs (valproic acid, carbamazepine,
lamotrigine)
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22. Consequences of Drug
Treatment for Mental Illness
 Number of people in mental hospitals
declined dramatically following the introduction
of drugs that control the symptoms of
schizophrenia to a great degree
 Outpatient community mental health
programs were set up to treat patients closer to
home in a more natural environment at less
expense
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23. Number of Patients in Nonfederal
Psychiatric Hospitals
•In 2008, the number of patients was 68,000, the same as 2004.
Data source: American Hospital Association
© 2011 McGraw-Hill Higher Education. All rights reserved.

24. Consequences of Drug
Treatment for Mental Illness
 Changes for psychiatrists
 Less time spent doing psychotherapy
 Priority and emphasis on establishing an
appropriate drug regimen
© 2011 McGraw-Hill Higher Education. All rights reserved.

25. Consequences of Drug
Treatment for Mental Illness
 Civil rights issues relating to hospitalization
 Indefinite commitment to a hospital is unconstitutional
 Periodic review of a patient’s status helps determine if
patient presents a danger to self or others
 Problems
 Patients may have well-controlled symptoms while on
medication in a hospital but may stop taking
medication upon release
 Unmedicated patients, although not overtly
dangerous, may still be too ill to care for themselves
© 2011 McGraw-Hill Higher Education. All rights reserved.

26. Consequences of Drug
Treatment for Mental Illness
 From hospital to jail or the
street
 More mentally ill persons are
jailed each year than are admitted
to state mental hospitals
 About one-third of all homeless
people have some form of serious
mental illness
© 2011 McGraw-Hill Higher Education. All rights reserved.

27. Chapter 8
Medication for
Mental Disorders
© 2011 McGraw-Hill Higher Education. All rights reserved.